A round-up of “how to’s”

Over the years, we’ve posted a lot of quick tips for vein care at home, so as a year-end gift we’re putting them all in one place!

• How to tell if you have venous disease
• How to keep your veins healthy in the winter
• How to do the “foot pump”
• How to properly elevate your legs
• How to treat venous symptoms naturally
• Quick tips for coping with spider veins 

Don’t forget that while these “how to’s” can help with the symptoms of vein disease, an evaluation by a qualified phlebologist can give you a complete picture of your venous health and options for treatment. If you ever have any questions, don’t hesitate to contact us at the Vein Healthcare Center.

Happy holidays from all of us at VHC!

One of our patients says: it’s definitely worth it

It’s that time of year when many of us review the things we’re grateful for. One of our patients is thankful for the advances in vein treatment – and for the way her quality of life has improved since her own treatment.

“About 15 years ago I had my varicose veins stripped the old way – surgery. That doctor made an incision from my thigh all the way down to my ankle. It required many stitches and a long recovery. Back then they didn’t have the nice compression hose or knee-highs that they do now; the hoses were thick, rubber and so uncomfortable I stopped wearing them.

After I had my children, a varicose vein formed in the middle of my right leg, and then a big varicosity starting forming on my knee. Every time summer came I always made sure to wear capri-length pants, and I hated wearing bathing suits.

I was reluctant to get my veins treated again because of my experience with the surgery 15 years ago, but I did my research and found Dr. Asbjornsen and the Vein Healthcare Center. I went in to talk to Dr. Cindy, and she and her ultrasound technician took an hour to find out where the source of the problem was. They took the time to find the source of why the varicose vein recurred in my right leg.

I went ahead and did the EVLA and was amazed at how fast it was – only an hour to stop the leak at the upper groin area. I had a pretty big bruise, but I used the Arnicare they gave me and wore my compression stockings. My thigh recovered so quickly!

Before the treatment you could actually feel the heat of the vein through my clothes. You could see the outline of the vein when I wore leggings, it was that bad. Now I can wear anything I want, even shorts. It would hurt at night too, but not anymore.

I have before and after pictures on my phone that I show to everyone! I tell people: Hey, just do it. It’s easy. Yeah, you have to wear stockings for a little while, but it’s definitely worth it.

I would absolutely recommend VHC. The whole practice was professional. They were very understanding about making appointments and worked with me the whole way. The doctor and her staff took a lot of time to explain the problem to me, and how they would resolve it. I think Dr. Cindy is a really good doctor. I felt very comfortable with her and never, ever felt rushed.”

-- Deanna B., 54, Old Orchard Beach, ME

We’re grateful for patients who are willing to share their experiences. To read more of our patients’ stories click here. Thank you for reading the @VHC blog – and have a happy and healthy holiday season!

New technology uses old-fashioned principles

What’s the best exercise for helping the veins return blood from the legs back up (against gravity) to the heart? Believe it or not, it’s good old-fashioned walking. Walking causes the

rhythmic contraction of calf muscles and helps promote blood flow to the heart.

What if you can’t walk for one reason or another? The foot pump is one way. Or you can try treadling!

A treadle is a foot-powered pedal or level used for circular motion, such as in a potter's wheel or sewing machine. At the Vein Healthcare Center, we sometimes recommend that patients use a machine called the CV2. Named for the natural “second heart” of the calf pump, the CV2 is essentially a treadle that uses momentum to keep the pedal—and the calf muscles—moving up and down for a long period of time and with minimal effort. It was invented by a physical therapist who used the concept of a sewing machine pedal in his design.

To learn more about this simply elegant machine, click here to read our latest issue of Vein Health News (Page 13 in the “New Alternatives” issue).

Treatment is individual

Just as every person is unique, so should every health treatment plan be.

If you decide to pursue vein treatment, be clear about what you want. Do you want to wear shorts or skirts again? Do you want your legs to feel good even after standing on your feet all day? Or are you happy to control your venous reflux with compression therapy?

Whatever your desired outcome, make sure you work with a doctor who will listen to you and help you achieve your goals. Of course, we recommend vein care from vein specialist certified by the American Board of Venous and Lymphatic Medicine (ABVLM).

Vein therapies today are performed by a variety of providers; some may lack adequate training or oversight, and some treat cosmetic concerns without taking the overall health and venous health of the patient into account.

Without a full understanding of both vein health and pathology, wrong treatment options can cause more damage to the venous system – and decrease your quality of life. When treated by a certified phlebologist committed to your overall health, you should receive professional medical care you deserve. 

If you’re wondering if you have symptoms of venous disease, click here to learn more about it.

Know Thrombosis: Blood clot awareness campaign returns

On October 13th it will once again be World Thrombosis Day, an opportunity for the general public and health professionals to learn about venous thromboembolism, or VTE. (October 13th is also the birthday of Rudolf Virchow, the German physician who pioneered the pathophysiology of thrombosis.)

We’ve talked a lot about DVT (deep vein thrombosis), PE (pulmonary embolism) and VTE, but it’s always helpful to learn more. For example, did you know that VTE is the leading cause of preventable hospital death, ahead of infection and pneumonia?

Take a look at the infographic below, and seek out more resources at the World Thrombosis Day site – including questions to ask your healthcare professional, risk factors for VTE, and your rights as a patient with regard to VTE.

One Patient’s Perspective

As the busy fall season kicks into high gear, we thought we'd take a minute to share a testimonial from one of our happy patients. Lucille used to do a lot of sitting because her legs felt so heavy and swollen. But now she walks at least 30 minutes every day!

"Dr. Asbjornsen is a rational, competent and caring physician. That's uncommon! From the first appointment, the doctor and her staff were very professional and continually demonstrated how much they care for their patients. Everyone was very thorough in educating me about each step of the process, from the evaluation to the follow-up—and they were pleasant too.

The group at the Vein Healthcare Center has restored my faith in the medical system. They are the cream of the crop. They're superlative!"

–      Lucille L., 69, Lewiston, ME

To read more about Lucille’s experience, check out the “One Patient’s Perspective” column in the latest issue of Vein Health News.

To see more of what our patients are saying, click here.

New alternatives in vein treatment

More and more people — doctors and the general public alike — know that so-called “vein stripping” is an antiquated treatment for varicose veins. Endovenous laser

therapy has been considered the gold standard in vein treatment for more than 20 years, but physicians in the field of phlebology are always seeking new, better techniques. The best vein specialists don’t stand still!

EVLA uses laser or radio frequency waves to create an intense localized thermal reaction in the incompetent vein. The thermal energy causes the vein to seal shut, stopping the healthy blood flow from entering the damaged vein, which keeps the blood flowing toward the heart properly.

In the latest issue of Vein Health News, we look at three non-thermal, non-tumescent vein treatments that are on the horizon. Simply put, “NTNT” modalities are newer procedures that do not require laser energy or radio waves, nor tumescent anesthesia.

To learn more about this and other current topics in vein healthcare, click here. And if you’re interested in a free subscription to Vein Health News, just click here.

Education is an important first step toward better vein health and an improved quality of life.

Men, women and veins

Gender and age are two primary risk factors in the development of venous insufficiency. The U.S. estimate for varicose veins is 40% in females and 22% in males. 72% of American women and 42% of men will experience varicose veins symptoms by the time they reach their sixties (although vein problems can occur at almost any age).

While it’s true that women are more likely than men to have venous disease, including varicose veins and spider veins, men are more likely to suffer from the worst vein problems, such as ulcers. Why is this the case?

Dr. Cindy Asbjornsen has observed that women tend to get help for their vein issues right away, while men will often wait until the problem becomes too painful to ignore. Leg ulcers, or wounds that won’t heal, are often the result. Conditions like varicose veins get worse with time, so the longer someone waits, the more extensive the condition—and often, the treatment.

Even men who are athletic are susceptible to venous disease. The important thing is to seek help for vein issues as soon as symptoms present themselves.

Symptoms of venous disease include:

•     Leg fatigue or heaviness – It is an early warning sign when legs feel good upon waking but are intensely tired or heavy at the end of the day.
•     Swelling – This can be caused by many things but also serves as a very early warning sign for vein problems.
•     Skin changes – Redness, skin thickening or other color changes on the legs and/or ankles is a common (and commonly overlooked) symptom.
•     Other skin changes, such as dermatitis, cellulitis, dry or scaly skin, or brown “stains” on the skin can be signs of advanced venous disease, and should be evaluated by a physician.
•     Spider veins – Blue- or purple-colored veins that occur under the skin but are close enough to be seen on the surface can be the “tip of the iceberg.
•     Varicose veins – Another sign of early stage venous disease, varicose veins are visible veins in the leg that bulge, often protruding through the skin.
•     Ulcers – An open wound on the leg or ankle that fails to heal can be the result of ongoing venous disease, often an indication that venous disease has reached an advanced stage.

Remember, some people with venous disease present with no symptoms, only skin changes and/or bulging veins. The key for anyone, regardless of gender, is to get evaluated as soon as he or she suspects there’s a problem.

Sclerotherapy Q&A with Alison Scheib, PA-C – Part 3

In our two previous posts we spoke with Alison Scheib, PA-C and sclerotherapy specialist at the Vein Healthcare Center, about post-treatment issues with sclerotherapy. In our final installment, we ask her some of the most popular questions that arise about this procedure. 

What are the most common side effects after treatment?

The most common side effects are bruising and tenderness of the treated veins. The bruising is usually fully resolved within two weeks and the tenderness responds well to heat and elevation. I do want to add that patients who follow the post-procedure guidelines for care will help promote the most effective healing. After each sclerotherapy session, compression stockings should be worn for 10 days, in most cases.

How much does sclerotherapy cost and does insurance cover it?

Costs vary, but it’s usually about $300-$500 per session based on how the vein is visualized (light-assisted vs. ultrasound). Insurers describe sclerotherapy as an “adjunct” procedure and will cover it in part or in full if a bigger procedure has been done in the past, such as radiofrequency or laser ablation, or if there is an open ulcer. Patients should work with their treatment provider to understand their health insurance coverage.

What is the one question that patients ask you the most?

“Will it hurt?” Everyone’s experience is different, but most people describe it as very tolerable. It is always possible to stop the procedure or take a break if someone does find it very uncomfortable, but most patients say there is only minor discomfort. The medicine is pH balanced and vein access is with a 27-32g (very small) needle so it’s really just a very small perceivable pinch.

If you have any questions about sclerotherapy, or what to expect before, during or afterwards, feel free to contact us at the Vein Healthcare Center: email connect@veinhealthcare.com, or call (207) 221-7799.

Sclerotherapy Q&A with Alison Scheib, PA-C – Part 2

In our last post, we discussed the basics of sclerotherapy with Alison Scheib, PA-C and sclerotherapy specialist at the Vein Healthcare Center. Now we talk with Ali about what to expect after a sclerotherapy procedure.

What should someone expect right after sclerotherapy?

Immediately following the procedure, there may be mild itching of your legs. It typically resolves within an hour. For the next few days, there may be some tenderness and bruising. About two weeks following the procedure, you may feel hard bumps in the area of the treated vein, which usually disappear over the course of several months.

How will the leg look or feel a week after sclerotherapy? A month?

Usually, the changes noticed in the first two months are improvement in symptoms. Patients have reported to me that their legs feel lighter, or without pain. The large, lumpy veins slowly disappear, usually 2-6 months after the procedure, and the smaller veins may disappear over the following six months. All veins clear up large to small, high to low. 

Are the results of treatment with sclerotherapy permanent?

Yes, once the vein has collapsed, it typically gets reabsorbed into the body and is permanently gone. Because that vein no longer exists, it cannot cause problems in the future. That said, all the veins in the body have the same genetic makeup and have generally been exposed to the same environmental stresses and, in theory, have the same risk of failing. In other words, if a patient has one bad vein, it is very likely that at some point they will have other bad veins. It’s important to note that healthy lifestyle changes can make a big difference in managing chronic venous issues and preventing future problems.

Can you go to work after treatment? What about exercise?

Yes, you can go to work after treatment. However, you should avoid heavy lifting and strenuous physical activity while standing for the first five days following sclerotherapy. Walking is great exercise after treatment. In fact, walking 30 minutes a day is a post-op requirement!

To read the conclusion of our conversation with Ali, click here. We ask some specific questions about common side effects and whether sclerotherapy is covered by insurance. Plus, the one question that patients ask most…

Sclerotherapy Q&A with Alison Scheib, PA-C – Part 1

Patients often have common questions about sclerotherapy, a minimally invasive procedure used to treat spider veins and varicose veins. To shed some light on the topic, here is a Q&A with Alison Scheib, PA-C, who specializes in sclerotherapy at the Vein Healthcare Center.

What is sclerotherapy?

Sclerotherapy is a medical procedure involving a series of injections into a dysfunctioning vein. The provider uses tiny needles to inject a medicine called a sclerosing agent into the vein's interior wall. This causes the vein to become sticky and seal shut, causing the troublesome vein to disappear. Blood then finds a healthy path back to the heart. “Ultrasound guided” or “light assisted” defines how the vein is visualized during these injections.

Can you explain the difference?

Ultrasound-guided sclerotherapy uses ultrasound echoes to locate veins that are not readily visible and cannot be seen with a light. This procedure is often used to treat perforator veins, or veins that connect the superficial system (above the muscles in your leg) to the deep system (veins under and between the muscles of the leg). During light-assisted sclerotherapy, a small, hand-held light illuminates the veins directly below the skin, which allows the sclerotherapist to clearly identify the source of the dysfunction.

Who is sclerotherapy best for?

Sclerotherapy works best for those with superficial veins that are not directly connected to deep veins by junctions and have a diameter less than 5 mm. It can also be highly effective in patients who have leg symptoms such as heaviness, aching, pain, itching, swelling, throbbing, or skin discoloration or breakdown.

How long does the treatment take? How many treatments do most patients need?

Number and length of each treatment varies from patient to patient. Each session can take between 15 minutes and one hour, depending on the complexity of vein patterns and reflux. Most patients need multiple treatments, 3-6 sessions, on average.

To read part two of our interview with Ali, click here!

Varicose veins during pregnancy—how to prevent them, how to treat them

In honor of Mothers Day, we’re discussing the topic of varicose veins during pregnancy, but with a focus on the positive: prevention and treatment. (We explore the effect of pregnancy on veins in greater depth in a previous blog post. Click here to read more.)

During pregnancy, the two most important preventative things to consider with vein care are periodically elevating the legs and compression. 

Maternity compression stockings come in a variety of styles and strengths, from knee-highs and thigh-highs, to full-length stockings. Many panty hose styles have more room in the belly and are specially designed to expand during pregnancy without restricting the abdomen. Maternity graduated compression stockings are specially designed to fit more snugly at the ankles and calves and less so toward the top. The gradual change in compression helps the weak valves in the veins to circulate the blood more effectively. Many women who wear maternity graduated compression report that it makes their legs feel great!

Though pregnancy compression stockings (and body garments) are available with a doctor’s prescription, many maternity stores also offer them. Accurate sizing is critical, so it is best to check with a doctor prior to purchasing any type of compression while pregnant.

In most cases, women can be safely treated for varicose veins 6-8 weeks after delivery. Hormonal levels are usually back to normal within that time (if the patient is not breastfeeding), and water retention and any clotting risks have usually returned to baseline.

           

Depending on the type of treatment, breastfeeding may be an issue for some patients. Treatments that require a local anesthetic, such as endovenous laser ablation (ELVA) or microphlebectomy, have been proven safe. Sclerotherapy is not recommended if the patient is breastfeeding, as certain medications used during this procedure have not been proven safe and may be excreted in breast milk. However, if the patient is willing to forgo breastfeeding for 24 hours, sclerotherapy is possible.

Another important preventive measure is knowledge. If someone in your family has had a history of vein issues, chances are you might too. Some vein specialists recommend that women seek evaluation, and possibly treatment, for problematic veins before their first pregnancy, especially if there is a strong family history of vein issues. Evaluation and education can be very important for preventing or controlling issues before you need treatment.

Aesthetic reasons, medical care

In vein care, we understand that people seek vein treatment for many reasons—discomfort, pain, and often, aesthetic reasons. But it’s important to remember that treatments for spider veins or varicose veins, as minimally invasive as they may be, are still medical procedures.

That’s why it’s important to be informed and go to a provider who is Board certified. The American Board of Venous & Lymphatic Medicine (ABVLM), formerly the American Board of Phlebology, was established in 2007 to improve the standards of medical practitioners and the quality of patient care related to the treatment of venous disorders and all aspects of venous disease.

The ABVLM also offers a Board Certification Exam, which ensures that physicians who specialize in phlebology (vein care) have met rigorous standards of education, experience, and evaluation. 

We came across this useful article called “Groupon Dos and Don’ts,” which shares tips on what to do before purchasing a “daily deal”-style coupon for medi-spa services. The best tip: do your research.

Looking for a place to start? Visit www.veinhealthcare.com, which offers a wealth of practical, easy-to-understand information.

Are there age restrictions for endovenous laser ablation treatment?

Treatment for most stages of vein disease can be performed on patients in their teens or in their nineties. Most people who possess motility—the ability to walk—are eligible for treatment. A thorough health history and physical exam should always be performed before any treatment.

It is worth noting, however, that aging is one of the leading risk factors for the development of vein issues. As people age, vein issues become more prevalent. Small problems that started earlier, often progress into larger ones. A decrease in the body’s production of collagen causes veins to become less elastic and more likely to “leak,” especially superficial veins. This is why there’s an increase of varicose veins in the elderly population.

Although seniors have a fifty percent greater chance of suffering from venous insufficiency, there is no research to suggest that their success rates after venous treatment are different from the their younger peers. It’s never too late to take charge of your health and feel better.

For more information about Dr. Cindy Asbjornsen, founder of the Vein Healthcare Center in South Portand, Maine, click here.

Leadership in the field of Phlebology

Dr. Cindy Asbjornsen, founder of the Vein Healthcare Center, is at the forefront of the emergent field of vein health. A nationally recognized phlebologist (vein specialist), Dr. Asbjornsen is the only doctor in Maine to be named a Fellow by the American College of Phlebology (ACP), a distinction held by only 56 other phlebologists in the country.

             

Since 2010, Dr. Asbjornsen has received numerous honors from the ACP, including first place recognition from the ACP’s 24th Annual Conference for her work on symptomatic middle cerebral artery embolism after foam sclerotherapy. In recent years, she has been invited to join the faculty of the ACP’s Annual Conferences as both presenter and judge.

 

In 2014, Dr. Asbjornsen was invited to help mentor the inaugural class of the ACP Leadership Academy, a program that encourages newly practicing and seasoned professionals to further the field of phlebology with a variety of projects. Dr. Asbjornsen worked with Drs. Hansen and Malvehy in their effort to educate the public about vein disease and treatment.

Click here to read more about the ACP Leadership Academy and the first class’ contributions to vein health!

Compression After Laser Treatment

In our last post we discussed the value of graduated compression stockings before an EVLA procedure. Now we turn to the use of compression after vein treatment. 

Graduated compression after EVLA has been proven to decrease swelling, a common outcome associated with the procedure. Additional benefits for the patient are decreased discomfort, potentially decreased risk of blood clots, and potentially decreased risk of pigmentation, or staining of the skin.

Immediately following an EVLA procedure, patients are asked to put on their compression stockings. Vein specialists will ask patients to wear compression stockings for the first two weeks following EVLA treatment, any time the patient is on her or his feet. (Compression stockings are also prescribed following sclerotherapy treatment, usually for between five days and two weeks.) Graduated compression stockings should never be worn to bed.

Compression is critical for the most efficient and effective healing process.

Compression Before Laser Treatment

For years, patients suffering from varicose veins and other vein conditions had few options for treatment. Now, endovenous ablation, or EVLA for short, is considered the gold standard in vein treatment. EVLA is minimally invasive procedure that is done on an outpatient basis, and recovery time for most people is very quick.

Graduated compression stockings play an essential role before and after vein treatments, including EVLA. Anyone that undergoes EVLA, sclerotherapy or other treatments for venous insufficiency must wear graduated compression stockings immediately following the procedure and during the recovery period. What some may not realize is that there are reasons to wear compression before treatment too.

Before a vein procedure, wearing compression stockings gives a person a snapshot of what vein health feels like. Since compression alleviates symptoms, it becomes easier for a phlebologist (vein specialist) to tease out, or confirm whether the leg pain is due to muscular-skeletal issues, the nervous system, or venous disease. Another benefit to wearing compression prior to treatment is that it’s good to confirm that the patient can tolerate stockings, and/or that the stockings fit properly. (After the procedure is the worst time to discover that the stockings don’t fit!)

Alternatively, many who think that they could never tolerate compression stockings try on a modern stocking and find them quite bearable. Since compression prevents the progression of vein disease and controls symptoms, some people may even decide to take a more conservative approach, rather than proceed with definitive treatment.

Vein disease isn’t always obvious

Vein disease isn’t always obvious. 

The 65-year-old woman in the picture to the right sought treatment because of the bulging veins in her right leg, but at her initial evaluation it became apparent that both legs were affected. Even more surprising, the vein problem was worse on her left leg than her right.

The patient had EVLA treatment on both legs, followed by ultrasound-guided sclerotherapy, and now enjoys healthy-looking legs that no longer ache.

If you have symptoms that you think may be related to venous insufficiency, read our previous blog post “How to tell if you have venous disease,” or click here to learn more. Even if you are experiencing only mild symptoms of venous (vein) disease, as the disease progresses it can lead to chronic venous insufficiency and result in serious medical complications.

How to tell if you have venous disease

Have you ever thought that the spider veins behind your knees have gotten bigger as you’ve gotten older? Or have you wondered why your legs feel so tired at the end of the day?

The American College of Phlebology (ACP) now offers a free, online vein self-assessment resource, which includes a questionnaire with eight simple questions to help determine if someone is at risk for vein issues.

Throughout the assessment, you’ll learn facts about vein issues to help you gain a better understanding of your own possible vein condition. Of course, an excellent way to find out if you do or do not have a vein disorder is to be evaluated by a Board-certified vein specialist.

To take the assessment screening, visit www.phlebology.org/VeinAssessment